Fraud Prevention

News & Analysis as of

HHS OIG FY 2016 Work Plan Outlines Oversight Priorities

The HHS OIG has released its FY 2016 Work Plan, which outlines the top audit, evaluation, and other legal and investigative initiatives that the OIG intends to conduct this fiscal year. As in years past, Medicare and Medicaid...more

The Escalating Cost of Counterfeiting

Counterfeiting is one of the fastest growing economic crimes of modern times. The rapid expansion of the Internet has only compounded the problem in recent years. The International Chamber of Commerce (ICC) estimates that in...more

Assistant Attorney General Caldwell Provides Guidance on Corporate Compliance Programs

In her year and a half as Assistant Attorney General in charge of the Criminal Division, Leslie R. Caldwell has repeatedly emphasized the importance of a company having a compliance program fine-tuned to its specific risks to...more

Risky Business – Five Facts You Should Know About the EMV Liability Shift

On October 1, 2015 the major payment card companies instituted the EMV Liability Shift in an effort to incentivize card issuers and merchants to migrate to using payment cards with embedded chips (“chip cards”) according to...more

Digital Insights & Trends: Embracing EMV Technology for Fraud Reduction and Loss Prevention

October 2015 represents a significant milepost in the migration of U.S. payments products to EMV chip technology. It also serves as a useful evaluation point as to what the technology achieves and where it falls short. By...more

Top Tips for Employers: Using Analytics to Make People Decisions

There is more data stored electronically now than ever before. This includes financial data, sales transactions, emails, instant messages, and employee activities, to name a few. Real value can be derived from analysis of...more

OIG’s Director of Medicaid Audits Testifies About Recommendation to Prevent Fraud in Personal Care Services

On September 11, 2015, the Office of Inspector General (OIG), Director of Medicaid Audits, John Hagg, testified before the House Committee on Energy and Commerce regarding areas in need of corrective action within the Centers...more

Business E-mail Compromise Scam v2.0

In March, we reported on the Business E-mail Compromise (BEC) scam where criminals target employees responsible for wiring company money, and trick them into wiring money under false pretenses to fraudulent accounts...more

Federal Reserve Board Issues Clarification on Treatment of Transactions-Monitoring Costs Under Regulation II

On August 14, 2015, the Board of Governors of the Federal Reserve System (the Board) published a clarification (the Clarification) of the Board’s decision to include transactions-monitoring costs in establishing the 21-cent...more

CFPB Releases Principles for Payment Systems

Why it matters - In an effort to provide guidance to payment systems looking to reduce "pocket-to-pocket" payment times, the Consumer Financial Protection Bureau (CFPB) released principles for consumer protection to...more

Senate Democrats Re-Introduce the Payroll Fraud Prevention Act of 2015 Soon After Hillary Clinton Seeks to Insert IC...

Shortly after Presidential candidate Hillary Clinton placed independent contractor misclassification in the national spotlight in mid-July 2015 when she prominently commented in a campaign speech upon the expanding use of ICs...more

CMS Fraud Prevention System Credited with $820 Million in Medicare Savings to Date

CMS has announced that its Fraud Prevention System identified or prevented $820 million in inappropriate Medicare payments during its first three years, including $454 million in 2014 alone. The Fraud Prevention System uses...more

Health Care Update - July 2015 #2

Congress Slowly Works on Budget Reconciliation; ACA Reform Proposals Still Up in the Air - The FY 2016 budget resolution, which was agreed to by Congress this past April, included broad reconciliation instructions...more

CMS Report Underscores Importance for Providers to Know Their Data

On July 14, 2015, CMS issued a report regarding its implementation of the Fraud Prevention System, which uses predictive analytics to manage government fraud and False Claims Act investigations. According to this report, CMS...more

Whistleblowing: An Employer’s Guide To Global Compliance

In This Issue: - Foreword - A Summary Across Five Continents - Law and Sanctions - The Legislative Framework: Whistleblower Protections Across the Globe - Global Differences: The Cultural...more

Four Strategies for Helping Employees Deal with Pressure and Stress at Work

How managers can help employees avoid unreasonable workplace pressure, which can lead to unethical behavior. A few of my recent focus groups with employees reminded me of a national survey that examined the sources and...more

Tales From The Crypt: Tale 2 - Tough Choices For Tough Cookies

Tough Cookie 1 has spent the more than half of her 20+ legal career working in the Integrity and Compliance field, and has been the architect of award-winning and effective ethics and compliance programs at both publicly...more

Mum’s the Word: New York’s Highest Court Maintains Anonymity in Auction Sales

In late 2012, we reported on a New York Appellate Division order that sent shockwaves and fear of instability through the auction house world. Late last month, the New York Court Appeals issued its opinion in the case of...more

California Court of Appeal Says Chevron Can Collect ZIP Code Information for Pay-at-the-Pump Transactions

On June 20, 2013, the California Court of Appeal affirmed the dismissal of a putative class action which alleged that Chevron violated California’s Song-Beverly Credit Card Act (“Song-Beverly”) by requiring California...more

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